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Title: Pretreatment with dual antiplatelet therapy in patients with ST-elevation myocardial infarction.
Austin Authors: Yudi, Matias B ;Farouque, Omar ;Andrianopoulos, Nick;Ajani, Andrew E;Brennan, Angela;Lefkovits, Jeffrey;Reid, Christopher M;Chan, William;Duffy, Stephen J;Clark, David J 
Affiliation: Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, University of Melbourne, Melbourne, Australia
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
School of Public Health, Curtin University, Perth, Western Australia
Department of Cardiovascular Medicine, Alfred Health, Melbourne, Australia
Issue Date: 2018 2017-09-30
Publication information: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2018; 92(2): E98-E105
Abstract: The optimal time to administer P2Y12 inhibitors in patients with ST-elevation myocardial infarction (STEMI) remains to be defined. We sought to assess whether a pretreatment strategy was associated with improved coronary reperfusion and clinical outcomes. Consecutive patients from the Melbourne Interventional Group registry (2005-2014) who presented with STEMI and underwent primary PCI were included. Those who received any P2Y12 inhibitor prior to arrival in the cardiac catheterisation laboratory were included in the pretreatment group. The primary endpoints were the proportion of patients with initial TIMI flow grade <3 and in-hospital bleeding. The secondary endpoints were 12-month mortality and major adverse cardiovascular events (MACE). Of the 2,807 patients included, 892(31.8%) received pretreatment. Clopidogrel was the most common P2Y12 inhibitor used (79.6%). Pretreatment was associated with less thromboaspiration and GPIIb/IIIa inhibitor use (both P < 0.01). Pretreatment was not associated with lower rates of TIMI flow <3 on initial angiogram (78.0% vs. 80.7%, P = 0.18) nor with increased in-hospital bleeding (3.6% vs. 3.9%, P = 0.67). Pretreatment was associated with lower 12-month mortality (4.7% vs. 7.0%, P = 0.02) but similar MACE rate (13.0% vs. 14.1%, P = 0.43). Multivariate analysis revealed pretreatment was not an independent predictor of 12-month mortality (OR 0.79; 95% CI 0.5-1.3, P = 0.32). Pretreatment with a P2Y12 inhibitor in patients with STEMI was not routine practice in our Australian cohort and was not associated with improved coronary reperfusion or clinical outcomes. Larger studies are required to definitively ascertain the risk/benefit ratio of dual antiplatelet therapy pretreatment in STEMI.
DOI: 10.1002/ccd.27325
ORCID: 0000-0002-3706-4150
PubMed URL: 28963757
Type: Journal Article
Subjects: STEMI
antiplatelet therapy
percutaneous coronary intervention
Appears in Collections:Journal articles

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